Provider Demographics
NPI:1508852336
Name:GUIDONE, LORI E (PA, LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:GUIDONE
Suffix:
Gender:F
Credentials:PA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6980
Mailing Address - Country:US
Mailing Address - Phone:503-975-3123
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 2205
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3287
Practice Address - Country:US
Practice Address - Phone:800-969-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORPA00584363A00000X
MI6401222861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
114371Medicare ID - Type Unspecified
S56228Medicare UPIN